Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G35952 | CA |
N | 207VE0102X | Reproductive Endocrinologist | G35952 | CA |
NPI | 1184664591 |
---|---|
Provider Name | Dr. John J. Willems |
First Address | Los Angeles, CA 90074-0001 |
Second Address | La Jolla, CA 92037-1027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 30/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G359520 | (05) | CA |
A46532 | (02) | CA |